Dental
Taking care of your oral health is not a luxury; it is a necessity for long-term optimal health. With a focus on prevention, early diagnosis, and treatment, Dental insurance can greatly reduce your costs when it comes to restorative and emergency procedures.
When you visit a dentist in the network, you will maximize your savings. These dentists have agreed to reduced fees, which means you won’t get charged more than your expected share of the bill.
DeltaCare USA (CA Only)
Plan Information
Plan Name: DeltaCare USA (CA Only)
Policy Number: 78783
Effective Date: 01/01/2025
Provider Network: Delta Dental
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Annual Plan Maximum
None
Preventive Care
$0
Basic Services
$0-$220 copay – See schedule of benefits
Major Procedures
$0-$195 copay – See schedule of benefits
Orthodontia (Adults and Children)
$1,900 copay/$1,700 copay
Plan Documents
Contact Information
Delta Dental PPO Low
Plan Information
Plan Name: Delta Dental PPO Low
Policy Number: 18543
Effective Date: 01/01/2025
Provider Network: Delta Dental
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Deductible (Individual/Family)
$100/$300
Annual Plan Maximum
$1,000; Combined In-Network and Out-of-Network
Preventive Care
$0
Basic Services
20% after deductible
Major Procedures
50% after deductible
Orthodontia (Adults and Children)
Not covered
Out-of-Network
Deductible (Individual/Family)
$100/$300
Annual Plan Maximum
$1,000; Combined In-Network and Out-of-Network
Preventive Care
20% after deductible
Basic Services
40% after deductible
Major Procedures
50% after deductible
Orthodontia (Adults and Children)
Not covered
Plan Documents
Contact Information
Delta Dental PPO High
Plan Information
Plan Name: Delta Dental PPO High
Policy Number: 18543
Effective Date: 01/01/2025
Provider Network: Delta Dental
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Deductible (Individual/Family)
$50/$150
Annual Plan Maximum
$2,500; Combined In-Network and Out-of-Network
Preventive Care
$0
Basic Services
10% after deductible
Major Procedures
40% after deductible
Orthodontia (Adults and Children)
50% up to a Lifetime Maximum of $1,000
Out-of-Network
Deductible (Individual/Family)
$50/$150
Plan Maximum
$2,500; Combined In-Network and Out-of-Network
Preventive Care
$0
Basic Services
20% after deductible
Major Procedures
50% after deductible
Orthodontia (Adults and Children)
50% up to a Lifetime Maximum of $1,000